Geological evolution of the Hampshire Basin (southern England) during a global climate transition from ‘hothouse’ to ‘coolhouse’ in the Palaeogene

Palaeogene sediments of the Hampshire Basin were a sensitive recorder of fluctuations in climate and eustatic sea level as Earth's climate transitioned from the global early Eocene ‘hothouse’ to the early Oligocene ‘coolhouse’, accompanied by the first permanent continent-scale glaciation of Antarctica at the Eocene/Oligocene boundary. A study of the Palaeogene sediments of the Hampshire Basin is not only interesting from a palaeoclimate perspective, but the marine middle Eocene formations are renowned for containing some of the most abundant and diverse Palaeogene fossil assemblages in the world. In this article, I take you on a tour of the geological evolution of the Hampshire Basin from the end of the Paleocene through to the Pleistocene. I highlight some of the best exposures where sediments can be studied at outcrop and representative fossil assemblages can be collected, along with the economic and archaeological significance of these Palaeogene sediments.Publisher PDFPeer reviewe

Who are we protecting? Exploring counsellors' understanding and experience of boundaries

The concept of boundary is a term often used within counselling and psychotherapy literature. However, there is a paucity of research exploring how useful and meaningful boundaries are for therapy practice. This study explored how counsellors understand and experience boundaries within their counselling practice. Seven participants, who were all qualified and practising counsellors, were interviewed about their understanding and experience of boundaries. These interviews were transcribed and then analysed using interpretative phenomenological analysis (IPA). Analysis identified one significant overarching theme entitled “Protection and Safety” which distinguished between the protection of self and other. This paper focuses solely on the Protection of Self theme because of the theme’s rich and vivid data and the theme’s overarching dominance across the accounts. Two subthemes were identified: Establishing the Self and Defending the Self. Findings indicate that there was a lack of awareness around boundaries, with some participants describing defensive responses to some boundary issues. However, participants also described using boundaries to restrict, limit and defend themselves when working with clients, and they identified this as necessary for their own safety and security. This study recommends that therapists should engage reflexively with boundaries, towards developing a more relational and/or client-focused approach

Who are we protecting? - Exploring counsellors’ understanding and experience of boundaries.

The concept of boundary is a term often used within counselling and psychotherapy literature. However, there is a paucity of research exploring how useful and meaningful boundaries are for therapy practice. This study explored how counsellors understand and experience boundaries within their counselling practice. Seven participants, who were all qualified and practising counsellors, were interviewed about their understanding and experience of boundaries. These interviews were transcribed and then analysed using interpretative phenomenological analysis (IPA). Analysis identified one significant overarching theme entitled “Protection and Safety” which distinguished between the protection of self and other. This paper focuses solely on the Protection of Self theme because of the theme’s rich and vivid data and the theme’s overarching dominance across the accounts. Two subthemes were identified: Establishing the Self and Defending the Self. Findings indicate that there was a lack of awareness around boundaries, with some participants describing defensive responses to some boundary issues. However, participants also described using boundaries to restrict, limit and defend themselves when working with clients, and they identified this as necessary for their own safety and security. This study recommends that therapists should engage reflexively with boundaries, towards developing a more relational and/or client-focused approach

Safeguarding children who are exposed to Abuse Linked to Faith or Belief

This is the peer reviewed version of the following article: Oakley, L., Kinmond, K. S., Humprheys, J. & Dioum, M. (2019). Safeguarding children who are exposed to Abuse Linked to Faith or Belief. Child Abuse Review. 10.1002/car.2540, which has been published in final form at https://doi.org/10.1002/car.2540. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.Cases of child abuse linked to faith or belief (CALFB) continue to be documented. However, there is limited research and understanding of CALFB. Further, there is a lack of clarity of definition. These factors then impact upon effective practice. Recognising this, the National Working Group for CALFB called for research on which to develop evidence-based practice. This paper reports on key findings from a mixed-method online survey which was completed by 1361 participants from a range of practitioner and community groups. The participants identified the importance of policy and multiagency working in this area, but they acknowledged the complexity and challenges associated with developing and implementing good practice. Recommendations from the study include a review of relevant policy to evaluate its application to CALFB, the development of faith literacy training for frontline practitioners and the creation of a space in which statutory, faith and community groups can dialogue

Patients’ perceptions and experiences of living with a surgical wound healing by secondary intention : a qualitative study

Background: Most surgical wounds heal by primary intention, that is to say, the edges of the wound are brought together with sutures, staples, adhesive glue or clips. However, some wounds may be left open to heal (if there is a risk of infection, or if there has been significant tissue loss), and are known as ‘surgical wounds healing by secondary intention’. They are estimated to comprise approximately 28% of all surgical wounds and are frequently complex to manage. However, they are under researched and little is known of their impact on patients’ lives. Objectives: To explore patients’ views and experiences of living with a surgical wound healing by secondary intention. Design: A qualitative, descriptive approach. Settings: Participants were recruited from acute and community nursing services in two locations in the North of England characterised by high levels of deprivation and diverse populations. Participants: Participants were aged 18 years or older and had at least one surgical wound healing by secondary intention, which was slow to heal. Purposeful sampling was used to include patients of different gender, age, wound duration and type of surgery (general, vascular and orthopaedic). Twenty people were interviewed between January and July 2012. 2 Methods: Semi-structured interviews were conducted, guided by use of a topic guide developed with input from patient advisors. Data were thematically analysed using steps integral to the ‘Framework’ approach to analysis, including familiarisation with data; development of a coding scheme; coding, charting and cross comparison of data; interpretation of identified themes. Findings: Alarm, shock and disbelief were frequently expressed initial reactions, particularly to “unexpected” surgical wounds healing by secondary intention. Wound associated factors almost universally had a profound negative impact on daily life, physical and psychosocial functioning, and wellbeing. Feelings of frustration, powerlessness and guilt were common and debilitating. Patients’ hopes for healing were often unrealistic, posing challenges for the clinicians caring for them. Participants expressed dissatisfaction with a perceived lack of continuity and consistency of care in relation to wound management. Conclusions: Surgical wounds healing by secondary intention can have a devastating effect on patients, both physical and psychosocial. Repercussions for patients’ family members can also be extremely detrimental, including financial pressures. Health care professionals involved in the care of patients with these wounds face multiple, complex challenges, compounded by the limited evidence base regarding cost-effectiveness of different treatment regimens for these types of wounds

Surgical wounds healing by secondary intention: characterising and quantifying the problem, identifying effective treatments, and assessing the feasibility of conducting a randomised controlled trial of negative pressure wound therapy versus usual care

Background: Most surgical incisions heal by primary intention (i.e. wound edges are apposed with sutures, clips or glue); however some heal by secondary intention (i.e. the wound is left open and heals by formation of granulation tissue). There is, however, a lack of evidence regarding the epidemiology, management, and impact on patients’ quality of life of these surgical wounds healing by secondary intention (SWHSI), resulting in uncertainty regarding effective treatments and difficulty in planning care and research. Objectives: To derive a better understanding of the nature, extent, costs, impact and outcomes of SWHSI, effective treatments and the value and nature of further research. Design: Cross-sectional survey; inception cohort; cost-effectiveness and value of implementation analyses; qualitative interviews; and a pilot, feasibility randomised controlled trial (RCT). Setting: Acute and community care settings in Leeds and Hull, Yorkshire, UK. Participants: Adults with (or for qualitative interviews, patients or practitioners with previous experience of) a SWHSI. Inclusion criteria varied between the individual Workstreams. Interventions: The pilot, feasibility RCT compared negative pressure wound therapy (NPWT) – a device applying a controlled vacuum to a wound via a dressing - with Usual Care (no NPWT). Results: Survey data estimated that treated SWHSI have a point prevalence of 4.1 per 10,000 population (95% CI: 3.5 to 4.7). SWHSI most frequently occurred following colorectal surgery (n=80, 42.8% - Cross-sectional survey, n=136, 39.7% - Inception cohort), and were often planned before surgery (n=89, 47.6% - Survey, n=236, 60.1% - Cohort). Wound care was frequently delivered in community settings (n=109, 58.3%) and most patients (n=184, 98.4%) received active wound treatment. Cohort data identified hydrofibre dressings (n=259, 65.9%) as the most common treatment, although 29.3% (n=115) participants used NPWT at some time during the study. SWHSI healing occurred in 81.4% (n=320) of participants at a median of 86 days (95% CI: 75 to 103). Baseline wound area (p=<0.01), surgical wound contamination (determined during surgery) (p=0.04) and wound infection at any time (p=<0.01) (i.e. at baseline or post-operatively) were found to be predictors of prolonged healing. Econometric models, using observational, cohort study data, identified that with little uncertainty, that NPWT treatment is more costly and less effective than standard dressing treatment for the healing of open surgical wounds: Model A (ordinary least squares with imputation): Effectiveness: 73 days longer than those who did not receive NPWT (95% Credible Interval (CrI): 33.8 to 112.8); Cost Effectiveness (Associated incremental quality adjusted life years): -0.012 (SE 0.005) (Observables); -0.008 (SE 0.011) (Unobservables) , Model B (Two Stage Model – Logistic and linear regression): Effectiveness: 46 days longer the those who did not receive NPWT (95% CrI: 19.6 to 72.5); Cost Effectiveness (Associated incremental quality adjusted life years): -0.007 (Observables) and -0.027 (Unobservables) (SE 0.017). Patient interviews (n=20) identified initial reactions to SWHSI of shock and disbelief. Impaired quality of life characterised the long healing process, with particular impact on daily living for patients with families or in paid employment. Patients were willing to try any treatment promising wound healing. Health professionals (n=12) had variable knowledge of SWHSI treatments, and frequently favoured NPWT despite the lack of robust evidence, The pilot, feasibility RCT screened 248 patients for eligibility and subsequently recruited and randomised 40 participants to receive NPWT or Usual Care (no NPWT). Data indicated that it was feasible to complete a full RCT to provide definitive evidence for the effectiveness of NPWT as a treatment for SWHSI. Key elements and recommendations for a larger RCT were identified. Limitations: This research programme was conducted in a single geographical area (Yorkshire and the Humber, UK) and local guidelines and practices may have affected treatment availability and so may not represent UK wide treatment choices. A wide range of wound types were included, however, some wound types may be underrepresented meaning this research may not represent the overall SWHSI population. The lack of RCT data on the relative effects of NPWT in SWHSI resulted in much of the economic modelling being based on observational data. Observational data, even with adjustment, does not negate the potential for unresolved confounding to affect the results. This may reduce confidence in the conclusions drawn and may lead to calls for definitive evidence from an RCT. Conclusions: This research has provided new information regarding the nature, extent, costs, impacts and outcomes of SWHSI, treatment effectiveness and the value and nature of future research; addressing previous uncertainties regarding the problem of SWHSI. Aspects of our research indicate that NPWT is more costly and less effective than standard dressing for the healing of open surgical wounds. However, because this conclusion is based solely on observational data it may be affected by unresolved confounding. Should a future RCT be considered necessary, its design should reflect careful consideration of the findings of this programme of research

Using a modified Delphi methodology to gain consensus on the use of dressings in chronic wounds management

Objective: Managing chronic wounds is associated with a burden to patients, caregivers, health services and society and there is a lack of clarity regarding the role of dressings in improving outcomes. This study aimed to provide understanding on a range of topics, including: the definition of chronicity in wounds, the burden of illness, clinical outcomes of reducing healing time and the impact of early interventions on clinical and economic outcomes and the role of matrix metalloproteinases (MMPs) in wound healing. Method: A systematic review of the literature was carried out on the role of dressings in diabetic foot ulcer (DFU), and venous leg ulcer (VLU) management strategies, their effectiveness, associated resource use/cost, and quality of life (QoL) impact on patients. From this evidence-base statements were written regarding chronicity in wounds, burden of illness, healing time, and the role of MMPs, early interventions and dressings. A modified Delphi methodology involving two iterations of email questionnaires followed by a face-to-face meeting was used to validate the statements, in order to arrive at a consensus for each. Clinical experts were selected, representing nurses, surgeons, podiatrists, academics, and policy experts. Results: In the first round, 38/47 statements reached or exceeded the consensus threshold of 80% and none were rejected. According to the protocol, any statement not confirmed or rejected had to be modified using the comments from participants and resubmitted. In the second round, 5/9 remaining statements were confirmed and none rejected, leaving 4 to discuss at the meeting. All final statements were confirmed with at least 80% consensus. Conclusion: This modified Delphi panel sought to gain clarity from clinical experts surrounding the use of dressings in the management of chronic wounds. A full consensus statement was developed to help clinicians and policy makers improve the management of patients with these conditions

Evaluating qualitative research

A chapter that discusses quality criteria in qualitative research